Comment je réponds au clinicien qui me demande de classer (selon ISSVA) une tache de naissance?

Transcription

1 Comment je réponds au clinicien qui me demande de classer (selon ISSVA) une tache de naissance? Ph. Clapuyt, L. Boon Cliniques universitaires saint Luc Université catholique de Louvain 1200 Bruxelles

2 Les angiomes

3

4 are imaging studies helpful for diagnosis of vascular malformations? in the vast majority : NO

5 in the vast majority : NO VM

6 caveats : differential diagnosis venous malformation? lymphatic malformation? the radiologist is not always able to answer the question!

7 LM? - VM? VM (finger)

8 LM? - VM? LM (leg)

9 LM? - VM? VM

10 LM? - VM? LM

11 VM / LM: differential diagnosis some clues cyst-like channels VM draining vein(s) phlebolith(s) very slow flow filling during compression/ decompression

12 VM / LM: differential diagnosis some clues cyst-like channels VM draining vein(s) phlebolith(s) very slow flow filling during compression/ decompression LM variable sized cyst(s) frequent fluid/fluid (debris) level (hemorrhage) no flow into cyst vessels in septa not compressible

13 doubtful cases : Doppler US at rest compression venous malformation

14 phlebolith venous malformation

15 fluid-fluid levels a b T1 T2 lymphatic malformation

16 in the vast majority : NO CM

17 doubtful cases : Doppler US hemangioma?

18 hemangioma soft tissue mass vascular network

19

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21 hemangioma soft tissue mass vascular network ++ low RI (often < 0.50) fast flow in veins large feeding vessels and draining veins

22 hemangioma?

23 hemangioma

24 caveats : differential diagnosis soft tissue mass or swelling! mandatory for precise characterization and/or diagnosis

25 caveats : differential diagnosis

26 caveats : differential diagnosis rhabdomyosarcoma

27 caveats : differential diagnosis

28 are imaging studies helpful for diagnosis of vascular malformations? in the vast majority : NO in particular cases : NO but additional information for follow-up and treatment

29 in particular cases : NO but additional information for follow-up and treatment

30 Sturge - Weber syndrome MRI T1 + injection

31 in particular cases : NO but additional information for follow-up and treatment AVM

32 are imaging studies helpful for diagnosis of vascular malformations? in the vast majority : NO in particular cases : NO but additional information for follow-up and treatment in some cases : mandatory for precise characterization and/or diagnosis

33 in some cases : mandatory for precise characterization and/or diagnosis CM?

34 CM? no mass! nidus

35 arterio-venous malformation feeding artery fast flow low resistance RI pulsatility in vein

36 arterio-venous malformation feeding artery affected side feeding artery normal side

37 pre-therapeutic work-up sclerotherapy LM VM embolisation surgery

38 LM macrocysts

39 a b c LM microcysts d

40 pre-therapeutic work-up sclerotherapy embolisation surgery : anatomical landmarks

41 LM

42 imaging tools ultrasound + Doppler screening first modality morphology flow hemodynamic pattern MRI (or CT) cross-sectional anatomy depth extension arteriography (pre-)therapeutic approach

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44 venous malformation T 1 p r e T 1 p o s t

45 vascular birthmarks tumor - mass YES NO

46 vascular birthmarks tumor - mass YES NO typical vascular architecture atypical - no vessels

47 vascular birthmarks tumor - mass YES NO typical vascular architecture atypical - no vessels hemangioma NICH RICH

48 vascular birthmarks tumor - mass YES NO typical vascular architecture atypical - no vessels hemangioma NICH RICH malignant tumor benign tumor LM!

49 vascular birthmarks tumor - mass YES NO typical vascular architecture atypical - no vessels vascular malformation hemangioma NICH RICH malignant tumor benign tumor LM!

50 vascular birthmarks tumor - mass YES NO typical vascular architecture atypical - no vessels vascular malformation hemangioma NICH malignant tumor fast flow slow (no) flow RICH benign tumor LM!

51 vascular birthmarks tumor - mass YES NO typical vascular architecture atypical - no vessels vascular malformation hemangioma NICH malignant tumor fast flow slow (no) flow RICH benign tumor LM! arterio-venous malformation arterio-venous fistula

52 vascular birthmarks tumor - mass YES NO typical vascular architecture Doppler US atypical - no vessels Doppler US vascular malformation hemangioma NICH RICH malignant tumor benign tumor LM! fast flow Doppler US slow (no) flow Doppler US arterio-venous malformation arterio-venous fistula capillary malformation venous malformation lymphatic malformation